ebola

This little girl and her brother and sister lost their parents. The auntie is asking me to help her by taking the kids. I asked her, “If someone helped you support and empower her, would you could feel happy raising your sister’s children?”

“Of course!” She said.

Rebecca tells me she has symptoms and is scared. I took my gloves off and let my hair down because I was leaving for the day. I wasn’t scared, because she looked strong. We are bringing her meds and will keep a close eye on her. Obviously this is agonizing but we are doing all we can. Please pray for Rebecca with me.

I talked to local medical staff about serving West Point. Everyone I met was really lovely. There were 20 or 30 body bags with deceased people inside. I was scared but also at peace. This place has things under control.

Community leaders made the rounds in West Point and found 45 sick people in the areas they were able to check. Unfortunately, all of the clinics are at capacity and not able to receive people.

These are stories of people trying to be resilient in the absence of any real government help. These slum dwellers had only two options if they wanted to survive: wait for the Powers to come save them, or become self-reliant. Resilience won, because they were used to being ignored. And while the medicine, supplies, and training were delivered by non-governmental groups like MoreThanMe, the people running the ambulances, screening citizens, and handing out the food were community members. The community saved itself. It illustrates a larger truism that we keep denying: Only the Poor can end poverty. Allow me to explain why.

First, a little more of my backstory. My job for the past few years was figuring out how to give Voice to the Poor. I ran an East African storytelling project with GlobalGiving from 2010 to 2013. It showed that the Poor clearly were the “experts” on what they needed, and knew how their governments could solve big problems. But my straightforward approach – collect their first-hand testimony and present it to those in power – wasn’t enough. Why? Because governments and international agencies are not built for listening. They have no effective mechanisms to redress complaints. They don’t give local leaders and local solutions a fair hearing.

Most people are eager to speak up at first, but experience teaches them that Power doesn’t care about the Poor. If they complain about a program, the donors too-often go elsewhere and start over, leaving those people with nothing. Spurned and punished for their participation, they don’t speak out.

It is not just organizations. Governments and business have also taught the Poor to merely accept what is offered. Business offers the Poor jobs that sacrifice wages or safety through the unregulated markets of Globalization. Governments are “representative democracies” at best, not direct democracies. Few representatives really listen to the Poor. Power listens to Power. The Poor survive on what they get, and only take to the streets and assert their rights when hardship becomes unbearable.

But sometimes a community does come together and builds something. Ebola’s demise in 2015 is the story of local leaders rising out of the chaos and helping neighbors choose resilience over fatalistic resignation, as I profile in my book.

Their stories are often untold, because telling their story to outsiders doesn’t help them along the path of self-reliance or survival. A reporter swooping in to get the story gives the storyteller fresh hope that someone will save him. There are millions of international do-gooders in the world spending their lives in an effort to help the Poor. We live among the Poor. We listen to them. We share their stories with a broader audience. Sometime we raise awareness about an issue. Occasionally we inspire the Poor. But mostly we offer a twisted hope that keeps them off the path of self-reliance. We cannot end poverty for the Poor, only enable to Poor to lift themselves up.

In a famous letter from a law professor to his student, Bill Quigley writes:

“Many come to law school because they want to help the elderly, children, people with disabilities, victims of genocide, victims of racism, economic injustice, or religious persecution. Unfortunately, the experience of law school and the legal profession often dilute that commitment.”

It is a harsh lesson I keep learning over and over. Regardless of my tactic, Peace Corps, science, banking, or medicine, the end result only moves the Poor a few feet from where they once stood. No mix of skills or tools or toys may ever work if I am the one holding the chalk, the shovel, or the smart phone.

Singing “No one is coming to save us!”

Katie Meyler once said that things started getting better when the people of West Point slum starting singing “No one is coming to save us!” It was a turning point. They understood that local leaders were their best hope for survival. The people were finally taking charge of their own future. The narrative changed from being about the failure of outsiders to the success of the community. And when West Point slum’s death toll fell far short of projections in the months that followed, locals could look at each other and say with pride, “We did this ourselves!”

This isn’t about outsiders abandoning the Poor, but about truly Serving the Poor.

But in our world, when stories like these are told by outsiders, the people who supply the materials take the credit. The bags of rice are stamped ‘US AID from the American People’.

The medicines and the trucks and the soldiers all have branding. But the people remain anonymous because they are the community being helped. It is a false narrative to separate the helpers from the helped. Serving the Poor means being in the community, without identity.

Instead, the locals are given supporting roles, first in the narrative, and later in the power restructuring following success (during the elusive “project replication” phase that funders seek). The meeting rooms usually look like this (a bunch of acronyms working together):

Newsmakers and storytellers and politicians must unlearn bad habits. Every success story is, at its core, about people helping themselves. We outsiders are mere bystanders. But with hard work we can become true servants.

Take another example, this time from the 1960s US Civil Rights movement. One witness tells the story of the political parade that was the funeral for Rev. James Reeb, who was brutally murdered in Selma in 1965:

From the balcony I saw a sea of dignitaries clearly unrelated to the events in Selma. Many faiths had come to pay tribute in this memorial to James Reeb. Until Dr. Martin Luther King himself spoke, it is hard to imagine a more jumbled collection of prepared prayers and speeches rattled off in a patronizing way. It was ecclesiasticism at its worst. James Reeb’s death was described as the most monstrous example of brutality, when in fact it was one more instance in a long series. Men who had not taken the time to meet any young people praised them for their courage. The men and women who had come “thousands of miles” for the memorial were extolled. I thought that it was not too difficult to come and go in 24 hours and have the vicarious experience of heroism through singing a few freedom songs.

When King began to speak, however, it suddenly seemed right that we should all be there. Everyone moved a bit in his or her seat when King asked rhetorically,

“Who killed Jim Reeb?”

He answered: A few ignorant men. He then asked,

“What killed Jim Reeb?”

and answered: An irrelevant church, an indifferent clergy, an irresponsible political system, a corrupt law enforcement hierarchy, a timid federal government, and an uncommitted Negro population. He exhorted us to storm the bastions of segregation and see to it that the work Jim Reeb had started be continued so that the white South might come to terms with its conscience.

So if local efforts do succeed, outsiders swoop in and take all the credit, and the Poor are pushed out of the limelight. Outsiders get promotions and the Poor find themselves only a few feet from where they began. Though nothing is won entirely without cooperation – and everything is at least partly enabled by those in Power – the distortion of who deserves credit is so large in the International Aid world that we’ve forgotten why it ever works at all. Everything starts because a community buys-in, and ultimately survives because a community takes ownership. We are just drifters and gamblers in their story.

Only the Poor can end poverty. But the rest of us can make that journey lighter.

It was no accident we find them in the slum at the center of a strong network of relationships. Katie spent 9 years there working for the community as a humble servant. Then in December of 2014, Time Magazine anointed her “Person of the year.” Now she’s brunching with billionaires instead of begging for books. But it is the same Katie, doing the same work. Serving Pearlina and Rebecca and other girls who deserve to go to school. She is part of the community. She was amazing and unknown before; now she amazes a bigger audience with grace:

They did not invent the process of community-building. It has been known for thousands of years. It is explained in Sun Tzu’s The Art of War:

“Come among the people.

Live among them.

Work with that they have.

Build on what they know.

And when the work is finished, they will say,

‘we have done this ourselves!'”

There has never been a better credo for fighting poverty, nor a better description of resilience. There are many technical ways to stop Ebola, but underneath every successful strategy is an appetite to empower resilient communities in precisely the way that Katie has. She didn’t know much about Ebola, but she knew a whole lot about inspiring people and organizing groups.

This is the most important lesson in my Ebola book for how we deal with the next crisis. Local leaders exist in every community, but too often our international systems co-opt their power and authority, replacing them in a state of emergency instead of empowering them. The sooner we can get a community singing, “No one is coming to save us,” the sooner that community can come together to save itself. Only then – and only through pre-existing local relationships – can international help be effective. No one from the Red Cross, WHO, CDC, and US army can live Sun Tzu’s credo in every town that might face a disaster in the future, and so these institutions need thousands of local allies. Only local voices can sing the melody in the resilience song.

A pro-Poor environment

If we want to hear the Poor speaking up, we must give them space to lead. We can create mechanisms to connect local voices with better performance in foundations and government (Keystone Accountability’s mission). We can reign in our proxy-democracy and make it more direct through functional citizen feedback loops (FeedbackLabs’s mission). We can listen to the Poor and let them speak in their own words (GlobalGiving’s Storytelling Project). These are all steps on the path to prosperity, but they are not the whole path.

NEW JERSEY – Katie Meyler, Founder of More Than Me, joins the Ebola Fighters named TIME’s Persons of the Year with her work highlighted in the Ebola Caregivers list. Meyler and the Ebola Fighters group join a list that in the past has recognized Winston Churchill, Ghandi, Pope Francis, and President Obama.

“The past few months have been filled with some of the most intense moments of my life, but they’ve also been some of the proudest. I’m honored to be listed next to these truly inspiring people and want to take this time to recognize everyone, on this list or not, who has helped fight Ebola on the front lines,” Meyler said.

This recognition comes out of great tragedy, but is a reminder of the need to continue the fight against Ebola until there are no new cases – and to move forward and rebuild as the epidemic ends. The mission of More Than Me has always been to expand educational opportunities for the most vulnerable girls from the West Point slum in Monrovia; but unable to stand by while their students were at risk, the organization shifted to rapid Ebola response programs in August. As Meyler puts it, “We don’t have an organization if we don’t have students who are alive.”

The tremendous efforts of Iris Martor, More Than Me’s school nurse turned Ebola Fighter, are also mentioned. While working in the community leading trainings to keep staff safe and coaching nurses, Martor’s 8-month-old girl became ill and she feared it was Ebola. When her daughter tested negative and recovered, Martor momentarily questioned the risk she was taking, but ultimately thought, “If someone from America comes to help my people, and someone from Uganda, then why can’t I? This is my country. I should take the first step.”

More Than Me is committed to caring for Monrovia communities that have been deeply affected by this outbreak. More Than Me’s team hopes to reopen their school and resume regular programming in early 2015, but is also committed to long-term support of survivors and the families of those affected by Ebola in their students’ communities. Next year, Meyler hopes to open a boarding school to offer a greater number of children an education including many Ebola orphans. Donations to support More Than Me’s work are matched until December 25th. Learn more here.

The TIME editors’ selection is based on “who best represents the news of the year,” spotlighting leaders who showcase “both a snapshot of where the world is and a picture of where it’s going.”

Most of the international stories surfacing deal with so much of the negative it seems hope is lost in the fight against Ebola. Well, I am here to bring you a new perspective. One I hope will inspire during this time of loss, uncertainty and fear. May this post shine brightly in the midst of the fight to contain Ebola.

Allow me to introduce you to some local survivors, who have now committed themselves to educating communities and working in Ebola facilities to comfort both families and patients. Please meet a few overlooked Ebola Fighters.

Mohamed and Zena are Ebola survivors from Guinea. Both became infected with the virus while caring for Mohamed’s older brother, who at the time, they were not aware had Ebola. The virus hit their family hard, with 9 becoming infected and 6 dying.

After recovering, Zena, a 24 year old school teacher and Mohamed, a 34 year old civil servant both lost their jobs from the stigmatization attached to the disease. Even with facing so much loss in their lives both knew they wanted to become more active in stopping the transmission of the virus so other families could survive and not endure the same pain they suffered from. They wanted to work to keep villages in tact and safe.

Medecins Sans Frontieres and other NGOs saw this as an opportunity and have deemed both Zena and Mohamed, Ebola Ambassadors. They go around communities contributing their personal stories to share knowledge, save lives and ultimately control the outbreak.

Then there is Salome Karwah of Liberia. Salome, her parents, fiance, sister and niece all became infected after her uncle contracted the virus by taking another infected woman to the hospital. Shortly after his death, Salome and her entire family, found themselves at an Ebola treatment center for care.

She describes her experience as:

“Severe pains were shooting inside my body. The feeling was overpowering: Ebola is like a sickness from a different planet. It comes with so much pain, and it causes so much pain that you can feel it deep in your bones.”

After 18 days, and following the loss of her parents, she tested negative for the virus and was able to go home with her fiance, sister and niece. After arriving home to fearful neighbors, she knew she needed to do more to educate and fight the stigma attached to Ebola. Currently Salome is back at the same treatment center who provided her care working as a mental health counsellor. She treats patients as family and shares her story to inspire them through it all.

Dr. Ada Igonoh a Nigerian doctor, takes you on an emotional rollercoaster as she recounts her experience surviving the deadly Ebola virus. A story so powerful, it has spread across the world like wildfire. Now as a survivor she uses some of her time to educate the world on her experience. She discusses her fears, the realities, thoughts and the tools she used to pull through the hardest of her days.

Sadly, Ebola continues to threaten the lives of millions. However, even through the storm, can light be seen. I found these stories to be inspirational aswe work to #EndEbola. We all have a part to play. To understand the magnitude of loss experienced by Mohamed, Zena and Salome and yet to see the passion blazing through them, now all working to care for their communities is a selfless act and one we should all aim to recognize. In fact, Time Magazine has deemed such actions as Heroic naming a few as ‘Person of the Year.‘

Let’s not further the stigmatization or lose sight of what it takes to end such a deadly virus. Instead educate yourself on the virus and take time to hear more stories of survivors and how they too change the tide of this current epidemic. Write a governmental official. Blog. Whatever positive action you chose to take could make the impact necessary to perhaps… just perhaps… #EndEbola.

It is rather astonishing here how much of the data I and others collect cannot be shared. It is not that the data is about things people don’t know. It is not that the data is about secret findings… it is about keeping the press and academics from saying stupid things and attributing it to WHO.

We have done a series of sensitivity analyses of the major CDC created surveillance system, the VHF, that everyone knows is incomplete. It is consistently 10 or 20% lower than the weekly district reports probably because somehow 10 or 20% of cases fail to be properly documented and transferred on through the steps of the surveillance process (e.g. the case report does not get filled out, or gets lost, or gets missed at the data entry office on the district level….or because half the freakin’ country have one of about six first and last names so they see 17 people named Mohammed Kumara from that district and think that their Mohammed Kumara has already been entered…). But, say out loud with data what everyone knows, for example that most of the cases are not being detected, and wow do the cheap seats in Atlanta and New York start rattling.

The most stunning censorship is the reluctance of anyone to show the epidemic curve. This is because the data takes time to get into the system (both the CDC VHF system and the MoHS “call to the Districts every day” system). It takes days for suspect cases to be tested and confirmed or sent home. It takes days for the data to get entered into the database. There are all kinds of delays… that when presented as an Epi curve, constantly give the impression that the outbreak has peaked and is coming down over the last two weeks.

Above is an example from New York Times of an apparent drop off in cases, but not a true one. It is due to counting errors.

(The original image was missing) This is mostly based on the MoHS data so the dip is not as dramatic as the VHF database. Most every reporter and fancy-pants modeler that has never done contact tracing or data entry form hospital forms will be tempted to report that the outbreak appears to be going down. This is actually what going up looks like. It would be fine if poorly informed people misinterpreted and then moved on to the crossword puzzle, but more often, the press officer and we in the office need to squander time explaining about data flow and delays. And then there are aberrant events.

If one looks at the week of September 21 above, it looks like there was a spike in suspected cases and then a dip. In fact, there was an outbreak of coding errors combined with the largest lab near Port Loko (the district with the highest incidence) shutting down for the week. Thus, those suspected cases from the week of September 21 mostly died without ever being laboratory confirmed and thus they will stay suspect forever. Since back in September, it took 4 or 5 days to get a lab test back (it is much shorter now), and then the data record had to be updated, typically cases that appeared as suspect in the week of Sept. 21 would mostly change to confirmed in the week of Sept. 28, but that never happened that week resulting in an artifact of apparently elevated numbers of suspect cases one week and fewer cases the next. There are issues like this or bigger in every data source I see every day… so people just do not share data and findings… not with the press, not with your peers who might share it with the press, and heaven knows not with Geneva!

As a West African, originally from Gambia, I am relieved that the glare of publicity about Ebola in New York City is waning along with the spread of the disease.

At the height of the Ebola crisis in the city, just around the time in October when Dr. Craig Spencer fell ill, I and other West Africans I knew here were scared of being tarred with the broad brush of Ebola, as if the deadly disease were endemic to the region and to us, even though its first flare up was in Central Africa in the 1970s.

Everywhere in the city, Ebola was a topic of discussion: in barbershops, in schools, in West African shops on 116th Street in Harlem. The barrage of Ebola news was inundating, inescapable for a West African like me.

One day I took a cab from 116th Street in Harlem heading home to Washington Heights. The cab driver, upon realizing my accent, asked about my nationality. I am a naturalized American but I replied, “Gambia.” He asked, “Where is that?” I responded: “West Africa.” Suddenly, and just as I had expected, an eerie silence fell upon us. A few minutes later, the driver, perhaps unsure of what to make of me, asked more questions: “So is your country safe from Ebola?” “How far is your country from Guinea?” “When was the last time you went home?”

I have not visited Gambia for years now, certainly not during the recent Ebola crisis in West Africa. But I reckoned that the driver was simply trying to be sure I had not come from any of the affected countries in the sub-region or gotten anywhere close to them. He was in danger-control mode. I wondered to myself that evening after he dropped me off if he had been comforted enough by what I had told him. Or if he was going to do his own “Ebola cleanup” inside his cab. I wasn’t sure.

On October 30, the famous singer Angelique Kidjo from Benin, West Africa, penned an op-ed in the New York Times recounting a similar encounter she had with a New York cab driver: “When I jumped into a taxi in New York recently,” she writes, “the driver asked me where I came from. When I said “I am West African,” he muttered one word: Ebola.”

The stigma of Ebola, like most stigmas, is fueled by ignorance, the reflexive inclination to lump all groups, and in this case, all countries, together. Yes, Ebola is in West Africa, but it is mainly in three countries: Guinea, Sierra Leone and Liberia. Yes, it is in those countries, but it is in certain areas, not the entire swathes of land, in each of those countries. Even though health agencies clearly labeled the affected countries on the African map, to help in the geographical understanding of the disease, some people still persisted in painting the entire West African region or the continent as a whole with the same image of Ebola.

It is hard to fight and overcome stigma, especially when it is ubiquitous and propelled into the public consciousness by a plethora of social media bent on providing information without context. In my interactions with some people in New York City, I have had to simply bat away their allusive comments about my West African-ness in connection with the spread of Ebola. I used to be upset. But I no longer am. Maybe because people have stopped asking me about Ebola.

From the Guardian: ‘Western area surge’ will use similar tactics to UK drink-driving campaigns to scare people into changing their behaviour

A Sierra Leonean health worker carries the body of a child for burial. Swab tests show that 30% of bodies picked up by burial teams are positive for Ebola. Photograph: Francisco Leong/AFP/Getty Images

The president of Sierra Leone will launch a massive campaign on Wednesday to curb the spread of Ebola in the western areas of the capital Freetown, which will aim to scare people into changing their behaviour.

The “western area surge” will use the sort of tactics that worked in the UK to discourage drink-driving, according to Donal Brown, head of the UK taskforce leading the international response in the country.

“We have got to go into every street, every house everywhere,” said Brown. “The western area surge is about massive social mobilisation and massive surveillance. “Freetown is not a place that feels scared or where people are bothered about Ebola. It is like the car crash or drink-driving campaigns in the UK. We want a campaign that says this is scary, this affects me – along the lines of, ‘Your neighbour stays at home? He kills you.’”

At the moment, swab tests show that 30% of bodies picked up by burial teams after calls from families are positive for Ebola. People are still nursing the sick rather than having them taken to holding centres for testing and then moved into treatment centres where half will probably die. It is in the last stages of the disease that victims are most infectious.

“We know it is out there. We have got to turn it around so that 2% to 3% of these bodies are actually positive,” said Brown.

The reluctance to make the call is rooted not only in family values but also cultural tradition around burials. In normal times, relatives would wash the bodies of those who die and dress them for the funeral. Many are still doing so – and calling the authorities afterwards, which means they have already exposed themselves to great risk.

“The behaviour change is not working,” said Brown. “We need to get to much more active surveillance, rather than passive surveillance.” Many thousands of people will be employed to visit communities and spread a tough new message in the course of the campaign, which will last for two to three weeks over the Christmas period. People now understand what Ebola is and what the risks are, but they are still in denial because they do not think it will happen to them, he said.

The latest data from the World Health Organisation shows a drop in the number of new cases in Sierra Leone, including Freetown, which may herald a flattening of the epidemic in the country as happened in Liberia – though it is also possible that the numbers will shoot up again as they did after dropping in Guinea. Last week there were about 250 fewer new cases in Sierra Leone, including a drop of about 100 in Freetown.

But as long as there are cases, there is the possibility of spread to a new region, triggering another outbreak. That has recently happened in rural Kono and in Kambia, the district north of Port Loko, which are causing real concern. In Kono in the eastern province bordering Guinea, it is thought men from Ebola-hit areas travelling for illegal diamond mining may have been a factor in the sudden outbreak.

Kono was unprepared. Some of the infections happened in a building being used as an isolation centre, where people who will have had other illnesses with similar symptoms such as malaria were being held with those who turned out to have Ebola. “We believe the spike is associated with unsafe burial practices and with poor infection control in a temporary holding centre,” said the UK’s Department for International Development.

The World Health Organisation reported 119 cases in Kono as of 9 December and said 87 bodies had been interred by burial teams stretched beyond their capacity before the alert was sounded and reinforcements drafted in.

KISSI TOWN, Sierra Leone — Military choppers thunder over the slums. Nearly a thousand British soldiers are on the scene, ferrying supplies and hammering together new Ebola clinics. Crates of food and medicine are flowing into the port, and planeloads of experts seem to arrive every day — Ugandan doctors, Chinese epidemiologists, Australian logisticians, even an ambulance specialist from London.

But none of it was reaching Isatu Sesay, a sick teenager. She flipped on her left side, then her right, writhing on a foam mattress, moaning, grimacing, mumbling and squinching her eyes in agony as if she were being stabbed. Her family and neighbors called an Ebola hotline more than 35 times, desperate for an ambulance.

For three days straight, Isatu’s mother did not leave her post on the porch, face gaunt, arms slack, eyes fixed up the road toward the capital, Freetown, where the Ebola command center was less than 45 minutes away.

“This is nonsense,” said M.C. Kabia, coordinator of the volunteer Ebola task force in Isatu’s area. Help rarely came, he said, and people were quietly dying all over the place.

While health officials say they are making headway against the Ebola epidemic in neighboring Liberia, the disease is still raging in Sierra Leone, despite the big international push. In November alone, the World Health Organization has reported more than 1,800 new cases in this country, about three times as many as in Liberia, which until recently had been the center of the outbreak.

More than six weeks ago, international health officials conceded that they were overwhelmed in Sierra Leone and reluctantlyannounced a Plan B. Until enough hospital beds could be built here, they pledged to at least help families tend to their sick loved ones at home.

The health officials admitted Plan B was a major defeat, but said the approach would only be temporary and promised to supply basics like protective gloves, painkillers and rehydration salts.

Even that did not happen in Isatu’s case. Nobody brought her food. Nobody brought her any rehydration salts or Tylenol. No health workers ever talked to her about who she might have touched, which means anyone directly connected to her could now be walking through Freetown’s teeming streets, where — despite the government’s A.B.C. campaign, Avoid Body Contact — people continue to give high fives, hug and kiss in public.

Community volunteers said Isatu’s case was the norm, not the exception.

“We have a huge number of death cases,” said Mr. Kabia, the volunteer Ebola coordinator in Isatu’s area, Kissi Town, adding that residents rarely survived because of the slow response.

Photo

On Freetown’s outskirts, burly youth are setting up roadblocks. The police are nowhere to be found. The young men barricade the road brandishing digital thermometers.CreditDaniel Berehulak for The New York Times

Discouraged, scared and furious, Sierra Leoneans are taking matters into their own hands. Laid-off teachers (all schools in this country are closed) race around on motorbikes, monitoring the sick. In some villages, informal isolation centers are popping up, with citizens quarantining one another, an incredibly dangerous ad hoc solution being performed without appropriate protection. (United Nations officials say this country is still short hundreds of thousands of protective suits.)

On Freetown’s outskirts, burly youth are setting up roadblocks. The police are nowhere to be found. The young men barricade the road, but instead of wielding weapons, they brandish infrared thermometers.

A passenger leaned out of the car while the ringleader scanned his head. 98.5. The posse then lifted the barricade, keeping anyone sick out of their neighborhood.

Fever is the scarlet letter of Ebola. Just about every important building in Freetown — hotels, banks, government offices — is now manned by a guard with an infrared thermometer and a bucket of diluted bleach for a mandatory hand wash.

But in the slums, it is a different story. In Kissi Town, an underserved area of dirt roads and dirty wells, the local Ebola task force said that more than 150 people had recently died of the virus, and that many had received no food, medicine or any other help.

Photo

Ebola patients waited in the recovery area after testing negative for the virus at a treatment center in Freetown, Sierra Leone.CreditDaniel Berehulak for The New York Times

Stuck in her house, waiting for an ambulance, Isatu kept burning up. She was intensely nauseated, she said, but still able to walk a few steps, an important factor.

“If they walk in, their chances are good,” said Komba Songu M’Briwa, a doctor at an Ebola clinic. “If they have to be carried in, well …”

By last Friday morning, Isatu was not walking anywhere. She had become too weak to stand. Her chances were plummeting.

She curled up on the floor, her jeans splotched with dried black vomit. She was delirious, eyes bolted open, huge and blank. A shadow would cross the threshold and they would not even flicker.

The virus was moving faster than all the aid workers put together.

“I’ve called 10 times myself, ” said Abu Bakar Kamara, a community volunteer, as he paced the scratched dirt yard in front of Isatu’s house. “No response.”

Photo

Health workers outside the high-risk area at the Hastings Ebola treatment unit in Freetown, the capital of Sierra Leone.CreditDaniel Berehulak for The New York Times

Sierra Leone has an elaborate Ebola response system — on paper. It starts with a call to 117, the toll-free number for central dispatch. A surveillance team is sent out, then an ambulance takes a patient to a holding center, then blood tests and a proper treatment center where the patient might receive intravenous fluids or other special care.

But the Ebola clinics do not have nearly enough beds, especially in Freetown, and an ambulance will not show up at a sick person’s house unless there is a bed somewhere for that patient. The government says it needs 3,000 beds nationwide but has fewer than half of that now.

Ambulances are hurtling across the country for hours to remote clinics in the east, where there are a few vacancies. The roads are horrendously bumpy; the jungle heat without reprieve. Many patients are dead on arrival.

Western officials are quick to add that even if all the resources were in the right place, that would not stop the virus.

“You can have as many helicopters, ships and kit here as you’d like,” said Lt. Colonel Matt Petersen, a British adviser. “But unless you change behavior, it’s not going to stop transmission.”

Public health professionals are beginning to look harder at Sierra Leone’s culture, which is dominated by secret men’s and women’s societies that have certain rituals, especially around burials. Many people here — just like in other cultures — believe that the afterlife is more important than this one. A proper burial, in which the body is touched and carefully washed, is the best way to ensure a soul reaches its destination.

It is not pure altruism, either. If burial traditions are not followed, people worry they may be haunted by a restless soul. But in a time of Ebola, handling corpses is extremely risky because they are highly infectious. Seventy percent of new cases here, Western officials said, are directly linked to traditional burials.

Kissi Town elders said that their outbreak started in early October after the funeral of a well-known society woman, as members of secret societies are called. Her name was Ya-Wullu, and she was known for handling dead bodies. After Ya-Wullu died from Ebola, an underling insisted on sleeping next to her corpse for three straight days. That second society woman then contracted Ebola too, and it shot through the community, elders said.

Neighboring Liberia has many of the same secret societies, but some anthropologists said that the Liberian government may have done a better job working with the leaders of secret societies to change burial practices, one possible reason Liberia’s Ebola crisis has been stabilizing.

Another issue are strikes. This week, burial workers in eastern Sierra Leone dragged corpses from a morgue and dumped them outside to protest delays in being paid. In Freetown last week, some surveillance workers — the emergency medical workers to suspected cases — refused to work, demanding back pay, which added to the problems of dispatching ambulances.

On Saturday afternoon, Isatu’s neighbors saw what they had been waiting for, rumbling up the road: a white truck with “Break the Chain” painted on the hood.

Help had finally arrived.

But this was not the Ebola team they had hoped for, evident by the way the workers slowly exited the vehicle and quietly suited up.

Isatu had died in the evening. The family said she was around 16 and loved a local game called balance ball.

The burial team moved fast, four white blurs through the door. Her mother seemed too exhausted to cry.

An hour later, all that remained of this teenage girl was a mound of dirt in a makeshift graveyard with a thin, flat stick poking out. The marker, placed in a growing forest of them, said “349, Isatu Sesay.”

There is a new important piece of information presented here “Seventy percent of new cases here, Western officials said, are directly linked to traditional burials.” If this is true it is a reasonable hypothesis to explain why this epidemic is so different from previous Ebola outbreaks. One previous estimate in the modeling for how the disease was spreading was that burial practices were about 17% of the basic reproductive number for Ebola in the region. However, if seventy percent of the transmission rate is actually due to religious burial practices, then without that factor the epidemic would end since the virus’s reproductive number would drop well below 1.
This estimate of the role of burial practices in spreading Ebola could explain the mysterious sudden drop on cases in Liberia as being the result of changed burial behavior. Also this would mean that when these burial practices mixed with the new introduction of Ebola then these religious burial practices then suddenly became severely counter survival. This is possibly the root cause of the epidemic and therefore may point to a rapid way to end the epidemic. Focus much more attention and assistance on burials and convince people to halt the burial practices that spread the disease and you could end the epidemic.

An Ebola treatment centre run by the Red Cross in Sierra Leone. Photograph: Francisco Leong/AFP/Getty Images

Bodies of Ebola victims have been dumped outside a hospital in Sierra Leone by burial workers, who are protesting at the failure of authorities to pay them bonuses for their hazardous work, residents have said.

Tensions in the eastern town of Kenema reached new heights with the action by members of the burial teams. Local residents said three bodies were abandoned in the hospital doorway, preventing people from entering. There were reports that 15 bodies in total had been left in the street.

Healthcare workers have repeatedly gone on strike in Liberia and Sierra Leone over lack of pay, unfulfilled promises to pay them more and their dangerous working conditions. Two weeks ago, health workers walked out of the Ebolatreatment centre in Bo, the only one in southern Sierra Leone, over the same issues.

A spokesman for the striking workers in Kenema, who asked not to be identified, said they had not been paid their weekly hazard allowance for seven weeks. Authorities accepted that the money had not been paid but said all the striking members of the Ebola burial team would be dismissed.

“Displaying corpses in a very, very inhumane manner is completely unacceptable,” said the spokesman for the National Ebola Response Centre, Sidi Yahya Tunis.

The head of the district Ebola response team, Abdul Wahab Wan, said the bodies had included those of two babies, and some had been displayed around the hospital.

The pressures on burial teams and health workers in Sierra Leone are severe as the case numbers continue to climb, in spite of a slow-down in neighbouring Liberia. Official figures from the World Health Organisation on 21 November showed there have been 6,190 cases in Sierra Leone, including 136 healthcare workers, and 1,267 deaths. There have been 15,351 cases and 5,459 deaths reported in the Ebola outbreak in total so far. The true figures are expected to be far higher.

Public Services International (PSI), a global trade union federation, has launched a video to name and honour 325 health workers, including doctors, nurses, ambulance drivers and cleaners, who have died of the disease in the three worst-hit countries. According to the WHO, 588 healthcare workers have been infected and 337 have died. Some will have lacked the personal protective equipment needed to do their job safely.

The federation said the “grievously high loss of lives” revealed a failure to invest in public health systems in the three worst-affected countries.

Anthony Banbury, head of the UN Mission for Ebola Emergency Response, said on Monday that the target of getting 70% of people with the virus into treatment and 70% of those who die safely buried by 1 December would not be met.

”In some places, we are definitely going to make it: we see some really good impact of the efforts of the national authorities and the United Nations system,” he said.

“It’s clear where there are escalating cases rapidly accelerating the spread of the disease, and where we don’t have the response capability on the ground, and that’s definitely the case in some places, we’re not going make it.”

The areas of greatest concern are in rural parts of Sierra Leone, the city of Makeni in the centre of the country, Port Loko in the north-west and the capital, Freetown.

Millions of dollars in aid have been pledged, troops have been sent by the UK and the US, and volunteer health workers are slowly arriving, but the epidemic in Sierra Leone is yet to show sign of abating.

For weeks it has been the same here in Sierra Leone’s capital, Freetown. Every day the Ebola burial teams – now well organised and promptly dispatched – collect about 60 bodies from around the city and its crowded suburbs.

Some days it is 50, sometimes as many as 80.

About 20% of those bodies turn out to be Ebola cases. The rest are just the usual range of deaths you might expect in a large city in West Africa. Every death is now treated as suspicious.

There is an air of brisk efficiency at the workers’ base – the British Council offices, on a hill overlooking the Atlantic Ocean, now transformed into an Ebola command centre for the western region of Sierra Leone.

In humanitarian aid there is often a strong focus on the biomedical angle of disease, as we can see right now in the Ebola crisis in West Africa. However, the role of religion should not be underestimated, as scholarly researchand media indicate that religious beliefs and practices can have a positive influence on prevention and treatment of disease. Barnet and Stein have argued that humanitarian aid is becoming increasingly secular. Bartelink and Wilkinson have both reflected on how this impacted on the humanitarian sector in its engagements with human rights and disaster risk reduction, in two posts on this blog before. In today’s post, Esther Loonstra argues that it is important to reflect on personal narratives of how religion can form mechanisms of coping and resilience during illness and disaster.

Ada Ignoh is a Nigerian nurse who survived Ebola after an outbreak in Lagos. She used various strategies to get emotional comfort and support from religion during her hospitalization in the Ebola clinic. For example, she would read Psalm 91 every morning:

The Lord will keep you safe from secret traps and deadly diseases. He will spread his wings over you and keep you secure. His faithfulness is like a shield or a city wall. … And you won’t fear diseases that strike in the dark or sudden disaster at noon. You will not be harmed, though thousands fall all around you.

As a nurse in the First Consultants Hospital Ada Igonoh cared for Patrick Sawyer, also known as ‘the man who brought Ebola to Nigeria’. She was one of the eight out of twelve directly infected by Sawyer that survived. Igonoh has written an extensive account of how she experienced having Ebola and the ways in which she used religion as a coping mechanism – through prayer, conversations with her pastor, seeking communion with other women in the clinic, reading the Bible, listening to messages of faith and healing (‘I continued listening to my healing messages. They gave me life’) and praising the greatness of God.

Igonoh’s story is not unique. Numerous studies have identified and significance of faith in healing and resilience and the different functions it can fulfil. Pargament and Cummings (2010) identify four major religious/spiritual functions that are important in resilience: (1) the search for meaning, (2) the quest for emotional comfort or anxiety reduction, (3) promotion of a sense of interconnectedness and (4) communion with the sacred. These elements can be seen as faith functions in the process of resilience and are not mutually exclusive, one or more may be used when coping with crises. The four faith functions can be seen as destinations or ends, which can be achieved through various ‘spiritual pathways’ such as beliefs, practices, relationships and emotions. The story of Ada Igonoh illustrates the spiritual pathways that can be taken as means towards the ends and can consist of various beliefs, emotions, practices and relationships. In the very detailed account of Igonoh we can see that she uses different pathways to fulfil the functions of resilience that are relevant to major functions of religion.

An example of a faith function such as the search for interconnectedness is when Igonoh describes herself as being tested in her faith. When a friend succumbed to Ebola ‘it was a great blow and my faith was greatly shaken as a result’. But she started a Bible study with the other female patients, she promoted her sense of social connectedness by forming relationships: ‘my communion sessions with the other women were very special moments for us all’. By actively engaging in religion, Igonoh built emotional resilience. She had ongoing contact with her pastor, also a doctor, who motivated her to do research about the illness (on her iPad) and to monitor very closely how many times she stooled and vomited. ‘My research, my faith, my positive view of life, the extended times of prayer, study and listening to encouraging messages boosted my belief that I would survive the Ebola scourge’.

From these ways of dealing with Ebola in relation to her faith and spirituality, Igonoh gained the mental strength to stay positive and to have faith in her process of recovery. Although people around her died, she managed to cope with the illness and stay positive.

In addition, religion can play a major role in emotional comfort. Empirical data also shows that religion can motivate people to take direct measures to solve problems such as disease. Various studies show that religion has a positive effect on health and has the potential to promote healthy prevention and treatment strategies. Research among seropositive African American mothers has for example shown that religious involvement reduced psychological distress. The authors also suggest that involvement in religious practices can be beneficial in the promotion of resilience. Thus, research shows that religious people do not ‘bury their heads in the sand’ when they appeal to spirituality in difficult times, but may be more engaged in actively resolving their problems.

While downplayed or ignored when looking through a biomedical lens, the story of Igonoh shows various strategies to cope with Ebola. It also raises a more practical point. Medics from contexts such as Nigeria or Liberia might more easily recognize that religion can be a motivator to be as proactive as possible in carrying out self-protective and healing measures. The pastor of Igonoh who also had a medical background is an example. Igonoh explains: ‘My pastor, who also happens to be a medical doctor, encouraged me to monitor how many times I had stooled and vomited each day and how many bottles of ORS I had consumed. We would then discuss the disease and pray together’. This example suggests that religious coping with the disease and medical approaches of prevention and cure can be complementary and acknowledged within their own roles and qualities.

Illnesses like Ebola or HIV/AIDS are often seen primarily through a biomedical lens, neglecting social, cultural or religious frameworks. Research suggests, however, that religion can promote practices that benefit patient’s recovery. In the practical reality of Ebola, as we can see in the story of Igonoh, this can mean consistently drinking ORS when infected, or seeking help a.s.a.p. when the illness is suspected. Thus, religion can play positive and motivational roles in coping with Ebola and contribute to the resilience of people in the face of adversity. Consequently, religion should not be overlooked in the sense that it can play a positive role in prevention, detection and healing the disease.

Yet, while religion’s contribution to promoting healthy behaviours that fit within a medical paradigm are becoming more widely recognised, religion’s effect on a patient’s emotional, spiritual and psychological wellbeing while coping with a deadly virus such as Ebola continues to be downplayed or ignored. While this is problematic in itself, it has the added consequence that the complementarity of religion and biomedical approaches to healing is lost and along with it an important and effective strategy for dealing with disease. The two fields should not be regarded as mutually exclusive. There should be room for religious practices because they can be beneficial for the recovery and resilience of the patient.

Coming back to the four major functions of religion relevant to resilience (search for meaning, emotional comfort and anxiety reduction, social interconnectedness and communion with the sacred), we can see the importance of spiritual guidance in the Ebola crisis as it can promote the way to recovery. Religious practices and beliefs can contribute to the wellbeing of patients and increase the legitimacy of healthcare. Humanitarian aid organisations responding to the Ebola crisis should therefore pay greater attention to the potentially powerful role that religion plays and support patients in meeting their religious and spiritual needs, as well as their physical needs.

Esther Loonstra is an intern at the Knowledge Centre Religion and Development in Utrecht and in the final phase of her master’s Religion and Globalisation at the University of Groningen. Her research focusses mainly on the (interconnectedness of the) fields of religion, gender, sexuality and health on the level of both policy and research.

One year ago, she died from complications in childbirth, a killer that every month takes twice as many lives as the entire Ebola epidemic. ... Many of these success stories were made possible through international development aid for maternal health, which increased steadily from 2010 to 2015.

Widow of Ebola Victim, Mother of Five Cries For Assistance March 18, 2018

Her story is probably more mind grappling than some of the famous stories told about the ugly impact left behind by the world's worst deadly Ebola virus outbreak in West Africa, including Liberia in 2014. Liberia became the worst affected with more than 5000 deaths. For Shianeh, every year Decoration ...

One year ago, she died from complications in childbirth, a killer that every month takes twice as many lives as the entire Ebola epidemic. ... Many of these success stories were made possible through international development aid for maternal health, which increased steadily from 2010 to 2015.

Widow of Ebola Victim, Mother of Five Cries For Assistance March 18, 2018

Her story is probably more mind grappling than some of the famous stories told about the ugly impact left behind by the world's worst deadly Ebola virus outbreak in West Africa, including Liberia in 2014. Liberia became the worst affected with more than 5000 deaths. For Shianeh, every year Decoration ...